J.Jpn. Surg. Soc.. 127(5): 496-501, 2026

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Feature topic

CURRENT STATUS OF AND CHALLENGES IN IMPROVING THE WORK ENVIRONMENT OF GASTROINTESTINAL SURGEONS

The shortage of gastrointestinal (GI) surgeons is a serious social and problem in Japan. A 2023 survey by the Work-In-Life Committee of the Japanese Society of Gastroenterological Surgery (JSGS) found that only 14％ of members would recommend a GI surgery career to their children, with projections that active GI surgeons under 65 years of age will be halved by 2043. Primary reasons for avoiding the specialty include poor work–life balance, unclear career trajectories, and psychological burden. The JSGS pursued dual strategies of improving remuneration and reforming the work environment, culminating in the 2026 medical fee revision. This introduced the Regional Medical Care Provision Security Allowance 2 and the Surgical Workforce Assurance Special Allowance, with the latter adding a 15％ premium to high-complexity, long-duration procedure fees, with at least 30％ mandatorily distributed to surgeons as a special bonus. Enabled by GI surgery’s uniquely severe workforce decline, this represents a historic first in Japan’s fee system: direct recognition and compensation of physicians in high-burden, understaffed specialties. This breakthrough is expected to extend to specialties with comparable burdens. Whether these measures reverse the decline warrants monitoring. Genuine workplace improvement requires team-based practice, progressive transition to shift systems (Figure 3), and digital information-sharing.

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